Provider Demographics
NPI:1518096437
Name:MCDONALD, PAMELA ANNE (SLP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANNE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:VANDERBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:PO BOX 1093
Mailing Address - Street 2:
Mailing Address - City:WAINSCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:11975
Mailing Address - Country:US
Mailing Address - Phone:631-725-5697
Mailing Address - Fax:631-725-5697
Practice Address - Street 1:77 UNION STREET
Practice Address - Street 2:OUT EAST OCCUPATIONAL THERAPY PC
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934
Practice Address - Country:US
Practice Address - Phone:631-874-0571
Practice Address - Fax:631-878-0527
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist